HomeMy WebLinkAbout1117 SAN JOSE AVE - Building Permits CITY OF COSTA MESA
• ii• BUILDING DIVISION
> 'r ll 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us
k FOR INSPECTIONS CALL: (714)754-5626
17%eft Nal so A
R?;a PERMIT NUMBER. B07-00924
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PERMIT TYPE B_ROOF2 STATUS: ISSUED
DATE ISSUED: 09/10/2007
ISSUED BY: BJK
JOB ADDRESS: 1117 SAN JOSE AV CM Suite/Unit:
Vicinity: RESIDENCE AND ATTACHED GARAGE
Squares: 2800 Valuation: -, $8,900.00
SCOPE OF WORK: REROOF RESIDENCE AND ATTACHED GARAGE:T(O EXISTING WOOD SHAKE,7(16"OSB,2 LAYERS 30#FELT,
APPLY"DURALITE SAXONY DURALITE TILES."5:12 PITCH 2800 SQ FT 5.9PSF ESR-1647
OWNER: SPENCER, GARY P Address: 1117 SAN JOSE AVE Unit:
•
PHONE: City/State/Zip: COSTA MESA, CA
•
APPLICANT: SELL, RON Address: 18032 LEMON Unit: :
PHONE: 714-528-1758 City/State/Zip: YORBA LINDA,CA
CONTRACTOR: SELL ROOFING COMPANY License No. 323842
Address: 18032 LEMONUnit: PHONE: 714-528-1758
City/State/Zip: YORBA LINDA,CA 92686 CELL:
ARCHITECT: - License No. . PHONE:
ENGINEER: License No. - - PHONE:
FEE SUMMARY
Reroof Plan Check: $0.00
Reroof Permit Fee: $167.25 .
Reinspection Fee: $0.00
TOTAL FEES $167.25
•
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord.No.92-28,§1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
CODE I. INSPECTION TYPE DATE INIMALS CODE INSPECTION TYPE DATE INRIIALE
1618 Fixed System Final Fire Prevention 206 Final Mechanical
1006 Pool Spa Final _ 208 Final Plumbing
200 Final Re-Roof «27 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Ptace 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
110
WORKERS'COMPENSATION DECLARATION. o
Owner ID verified by drive se. 0 Yes ❑ No
I hereby affirm under penalty of perjury one of the following declarations:- ' • Driver's License No. Expires:
❑ I have and will maintain a certificate of consent to self Insure for workers' Verification of Ownership by(type of document.i.e.-property tax bill or deed):
compensation, as provided for by section 3700 of the Labor Code, for the .
performance of the work for which this permit is issued. ,
—gave and will maintain workers'compensation insurance; as required by -
■6"ectiOn 3700 of the Labor Code,for the performance of the work for which this DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:'
permit is issued. My 'Yo�cA-err '' comp/e'n�sati�on/insurance 'carrier and policy 0 I hereby certify that no excavation five(5)or more feet in depth into which a
number are: /'�1 �"-"'Y person is required to'descend,will be made in connection with work authorized
__„..---..,r by this permit,and that no building structure,scaffdding,falsework,or demolition
Carrier: >. or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Gm
(Thi1 secton need not be completed r the perm_t:s vaNedal one hundred dollars(5100)or less.)
/G.4 6 5 ,[ 2,Art 2,Sec.341,Title 8,California Administrative Code).
P.alicy-Number. S `7
0 As owner-builder, I will not employ anyone to do work which would
'[�]--t'certify-thar in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above,unless
issued,I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division.
to the workers' compensation laws of California. and agree that if I should
become subject to the wor ers' compensation provisions of Section 3700 of Applicant's Signature Dare
the Labor Code,I shall 'th comp writ se provisions.
2/ Division of Industrial Safety Permit Number:
W.,:: T:Y,:;Applicant's Signature ate
w HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? 0 Yes 0 No
($100,000), IN ADDITION TO THE COST OF COMPENSATION. DAMAGES AS (Section 25505 of the California Health and Safety Code requires, with some
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND exceptions, that a Business Plan be filed with the Costa Mesa Fire
ATTORNEY'S FEES. Department by every business which has at any one time during a reported
year a quantity of hazardous materials equal to or greater than a weight of
LICENSED CONTRACTORS DECLARATION: 500 pounds,or a volume of 55 gallons, or 200 cubic feel of compressed gas
I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure).
with Section 7000)of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file
my license is in full force and effect, a registration form for acutely hazardous materials? ❑Yes ❑No
1
Lic:# 3d f 2-
4 Ctass# c (Section 25533 of the California Health and Safety Code, with some
(��// GP exceptions, requires registration with the Costa Mesa Fire Department by
x{P-C.t•.� - / each business which at any one time has on hand a quantity of acutely
¢, ; ,„ s Signature �,, .:ie.. i hazardous materials equal to or greater than a weight of 500 pounds, or a
.-____,-'' volume of 55 gallons, or 200 cubic feet of compressed gas at standard
CONSTRUCTION LENDING AGENCY: temperature and pressure).
❑ I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to
performance of the work for which this permit is issued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely
Lender's Name: hazardous materials)? 0 Yes 0 No
(Section 25534 of the California Health and Safety Code provides that the
Lender's Address: Costa Mesa Fire Department may require the preparation, certification and
filing with the Fire Department of an RMPP by businesses which are required
to register acutely hazardous materials with the Fire Department.
Signature Date
4. If an RMPP is presently required, has Section 25534 of the California
OWNER-BUILDER DECLARATIONS: Health and Safely Code been fully complied with? 0 Yes 0 No
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for
CONTRACTORS LICENSE LAW for the following reason (Sec- 7031.5, the work which is the subject of this application a permit for such construction
Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from
construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? ❑Yes 0 No
issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the California Govemment Code requires that the requested
that he or she is licensed pursuant to the provisions of the Contractors information be furnished on applications for non-residential building permits).
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and 6. Will any part of the facility to be constructed under this permit be within
the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? 0 Yes 0 No
applicant for a permit subjects the applicant to a civil penalty of not more than (If"yes", the facility must meet the requirement of Sections 25534 and 42303
five hundred dollars($500).): of the California Health and Safety Code).
❑ I, as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other
compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the
offered for sale(Sec.7044,Business and Professions Code:The Contractors subject of this application,have all of the disclosures prescribed by California
License Law does not apply to an owner of property who builds or improves , Health and Safety Code Section 42303 been made? 0 Yes 0 No
thereon,and who does such work himself or herself or through his or her own 8. (If"yes",attach certificate of compliance from the appropriate air pollution
employees, provided that such improvements are not intended or offered for
sale. If, however, the building or improvement is sold within one year ofcontrol officer).
completion. the owner-builder will have the burden of proving that he or she ' CERTIFICATE OF COMPLIANCE: 1 certify that under penalty of perjury the
did not build or improve for purpose of sale:). information given above is correct. I agree to comply with all state laws and
property, amEXCLUSIVELY CONTRACTING WITH city ordinances regarding Hazardous Materials and Emissions.
❑ I, as owner of the
LICENSED CONTRACTORS to construct the project(Sec.7044,Business and .
Professions Code: The contractors License Law does not apply to an owner of Signature Date
property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that
0 I am exempt under sec. _ the information given is correct. agree to comply with all state laws and city
ordinances relating to building construction, and authorize representatives of
Business and Professions Code for this reason: the City of Costa Mesa to enter upon the above-described property for
inspection purposes. I agree not to occupy or allow occupancy of any building
authorized by this p t�til finan
ecb .
5 ea
Sign eo eget O/rer(s)n r=e
Signature Dale 444 �� .f
305746(3l07) a/or/or Authorized �� y?";Date ,
•
CITY OF COSTA MESA
« ,
fas •
BUILDING DIVISION
FAH"II 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us
�. FOR INSPECTIONS CALL:(714)754-5626
et4b0.iffia^4.
PERMIT NUMBER: B07-00924
PERMIT TYPE B_ROOF2 STATUS: ISSUED
DATE ISSUED: 09110/2007
ISSUED BY: BJK
JOB ADDRESS: 1117 SAN JOSE AV CM Suite/Unit:
Vicinity: RESIDENCE AND ATTACHED GARAGE .. '
Squares: 2800 Valuation: $8,900.00
SCOPE OF WORK: REROOF RESIDENCE AND ATTACHED GARAGE:T/O EXISTING WOOD SHAKE,7/16"OSB,2 LAYERS 30#FELT,
APPLY"DURALITE SAXONY TILES."5:12 PITCH 2800 SQ FT 8.9PSF ESR-1647
OWNER: SPENCER,GARY P Address: 1117 SAN JOSE AVE Unit:
PHONE: • City/State/Zip: COSTA MESA,CA
APPLICANT: SELL, RON Address: 18032 LEMON. Unit: :
PHONE: 714-528-1758 City/State/Zip: YORBA LINDA,CA
CONTRACTOR: SELL ROOFING COMPANY License No. 323842
Address: 18032 LEMONUnit: PHONE: 714-528-1758
City/State/Zip: YORBA LINDA, CA 92686 CELL:
ARCHITECT: License No. - . PHONE .
•
ENGINEER: - - License No. - , PHONE:
FEE SUMMARY
Reroof Plan Check: $0.00
Reroof Permit Fee: $167.25
Reinspection Fee: $0.00
. .. /tit
•
TOTAL FEES $167.25 Ip
3
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord.No.92-28,§1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
CODER. INSPECTION TYPE DATE INTITIALS • COPE# INSPECTION TYPE DATE INTOIALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final -il 08 Final PI tubing
200 Final Re-Roof / � 0 Final Ele dca /
201 Final Block/Retaining Wall - 12 Fi I Fire revention
202 Final Factory Fire Place 220 Final Planning Appro al .-
. A
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
. r . . 3 ( 1
i
WORKERS'COMPENSATION DECLARATION: - Owner ID verified by driver Ise. ❑Yes ❑No
I hereby affirm under penally of perjury one of the following declarations: Driver's License No. Expires:
•
❑ I have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document,i.e.-properly tax bill or deed):
compensation, as provided for by section 3700 of the Labor Code, for the
pormance of the work for which this permit is issued. .
7l have and will maintain workers'compensation insurance,as required by • '
section 3700 of the Labor Code,fico the performance of the work forwhich this DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
permit is issued. My workers' compensation Insurce carrier and policy ❑ I hereby certify that no excavation five(5)or more feet in depth into which a
number are: . / ��/'f // person is required to descend,will be made in connection with work authorized
Garrier: '
�iKT. G-/U by this permit,and that no building structure,scaffdding,falsework,or demolition
— ..+ or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Gm
(This section need not be completed Alhe permIs vale
Lq at one hundred dollars(31 00)or less) 2,Arta Sec.341,Title 8,California Administrative Code).
Poficy.Numbei) /0 C 6 5-s(
S
❑ As owner-builder, I will not employ anyone to do work which would
❑ I certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above,unless
issued, I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division.
to the workers' compensation laws of California, and agree that if I should
become subject to the workers'compensation provisions of Section 3700 of
Applicant's Signature Date
the Labor Cod s all forthc ply with these provisions
UO Division of Industrial Safety Permit Number:
Aol nfs,6igl+ature roar HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? ❑Yes 0 No
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST,AND exceptions, that a Business Plan be filed with the Costa Mesa Fire
ATTORNEY'S FEES. Department by every business which has at any one time during a reported
year a quantity of hazardous materials equal to or greater than a weight of
LICENSED CONTRACTORS DECLARATION: 500 pounds,or a volume of 55 gallons,or 200 cubic feet of compressed gas
I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure).
with Section 7000) of Division.3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file
my license iS in-dg7ll force and effect. ,L rn a registration form for acutely hazardous materials? 0 Yes 0 No
CL'ic'.#� Z 3 7 Class.Jt-, 6 — 3 / (Section 25533 of the California Health and Safety Code, with some
/.. exceptions, requires registration with the Costa Mesa Fire Department by
'/C./Qi7" ��V� 7 each business which at any one time has on hand a quantity of acutely
oerra�tvrs slgnarWe�-.�' �e-p hazardous materials equal to or greater than a weight of 500 pounds, or a
volume of 55 gallons, or 200 cubic feet of compressed gas at standard
CONSTRUCTION LENDING AGENCY: - temperature and pressure).
o I hereby affirm that there ea construction lending agency for the 3. Does or will the applicant or present or future building occupant need to
performance of the work for which this permit is issued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely
Lender's Name: hazardous materials)? ❑Yes 0 No
(Section 25534 of the California Health and Safety Code provides that the
Lender's Address: Costa Mesa Fire Department may require the preparation, certification and
filing with the Fire Department of an RMPP by businesses which are required
to register acutely hazardous materials with the Fire Department.
Signature Date
4. If an RMPP is presently required, has Section 25534 of the California
OWNER-BUILDER DECLARATIONS: Health and Safely Code been fully complied with? 0 Yes ❑ No
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for
CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, the work which is the subject of this application a permit for such construction
Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from
construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? 0 Yes 0 No
issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the California Government Code requires that the requested
that he or she is licensed pursuant to the provisions of the Contractors information be furnished on applications for non-residential building permits).
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business'and Professions Code) or that he or she is exempt therefrom and 6. Will any part of the facility to be constructed under this permit be within
the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? 0 Yes 0 No
applicant for a permit subjects the applicant to a civil penalty of not more than (If'yes", the facility must meet the requirement of Sections 25534 and 42303
five hundred dollars($500).): of the California Health and Safety Code).
❑ I, as owner of the property. or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other
compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district Or agency is required for the work which is the
offered for sale(Sec.7044, Business and Professions Code:The Contractors subject of this application, have all of the disclosures prescribed by California
License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? 0 Yes 0 No
thereon,and who does such work himself or herself or through his or her own
8. (If•yes", attach certificate of compliance from the appropriate air pollution
employees, provided that such improvements are not intended or offered for
Sale. If, however, the building or improvement is sold within one year of control officer).
completion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certify that under.penalty of perjury the
,did not build or improve for purpose of sale.). , information given above is correct. I agree to comply with all state laws'and
LII, as owner of the property, am EXCLUSIVELY CONTRACTING WITH
city ordinances regarding Hazardous Materials and Emissions.
LICENSED CONTRACTORS to construct the project(Sec.7044,Business and
Professions Code:The contractors License Law does not apply to an owner of Signature Date
property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that
ID
exempt under sec. the information given is correct. I agree to comply with all state laws and city
Iordinances relating to building construction, and authorize representatives of
Business and Professions Code for this reason: - the City of Costa Mesa to enter upon the above-described property for
inspection purposes gree not to occupy or allow occupancy of Iny b ilding
- authorized by thi er it until f • I i sp tion. r/� (a
a7
/74
signal olr /al 5s{ / •.to
Signature Date JV C!/ /a a 7
305746(3/07)
tApolor.Authorizae APWtrant._..�5.
6125 1 /21 /81 232,35 ?4i
COSTA MESA BUILD'�'".ISAFETY DEPARTMENT APPLICA_ _,N FOR STRUCTURAL PERMIT ^ -'
P.O.BOX 1200 COST ESA,CALIFORNIA 92626 •
RECEIVE gV PERMIT N2 4 7 7 3 7
For Applicant to Fill in Completely— Use Ink Only U
BUILDING
ADDRESS 1117 San Jose Ave. A.P. NO. /ar� ,-
s / —SS
OWNER OR BUILDING
TENANT Wimbledon ASEIoc . ADDRESS 1117 San Jose Ave.
UNIT OR
MAILING 1470 Jamboree Rd SPACE NO. Lot 27
ADDRESS
CITY Beach TE 640-680 TR'N1D0275 LOT 27 BLK.
NewportTEL
_ NO.
NEW ADD ALTER REPAIR MOVING DEMOLISH
LOOENDERcnON Imperial Savings & Loan
X
BRANCH Pasadena Wimbledon Assoc.
OWNER (07/3.146
ADDRESS 61 So. Lake Ave . PRD VALUE C0 , 245
USE
ARCHITECT TE
ORENGWEElorbin/Yamafuji ND, 49-7124 . I/�[
ADDRESS 17992 Mitchell So. , Irvine ZONE PPR-03 YPE I'� GROUP I `- 3
APPROVED
CONTRACTOR McLain Dev. Co. BY °Lk DATE //22/g f
ADDRESS 1470 Jamboree Rd.
CITY Newport Beach
TEL
I•" APPROVED SETBACKS
xx. STATE CITY
LIC.NO. 273875 LIC.NO. 18873
SIZE NO.OF BLDGS. (FROM Ctt9^TRCCT) PL
4 OF LOT NOW ON LOT 0 FRONT cO� FT.
Q USE OF {
cn EXISTING BLDG. R.SIEIF tJ FT.
In
E-.
Separate permits are required for L.SIDE .5 FT.
6. electric,plumbing and heating work. REAR,?/.5-er-r.
w
F USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION
CI
CI
.] ZE-78"3 PRD - New construction DATE �11 �APPROVED �-y0:7(e
> Single-family dwelling APP v A
�i g2C �81
.41
ce aY HOLD FOR SPECIAL REQUIREMENT:
z
w
0 • I hereby acknowledge that I have read this application and state n
94 that the above information is correct and agree to comply with
4 all laws regulating building construction, and I shall not employ • / /S ��
ro 7 i
Z any person in violation of the workman's compensation laws of s /52 /
X the State of California. m v
h
5O. FT. N
I hereby certify that I am properly licensed es a contractor under
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR ro "'(�
J
Chapter 9, and that such licenses ere in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: n
am exempt from the provisions of the State of California Business VALUATION PERMIT FEE E o?.27,b�G Y
and Professions Code, Division 3,C ap er •.
e PLAN CHECK S
Signature of / c
i � V•
Permittee $/ ei � /_ V ,
or �7 's IV 1 TAX S C(),
Authorized Agent Date TOTAL PAID $—
OWENS-CORNING
Fibersps
Blanket Insulation
The contractor named below certifies that the Owens-Corning Fiberglas
Blanket Insulation used carries the NAHB Research Foundation, Inc. label
for assured thermal performance and that the Blanket Insulation is in-
stalled in conformance with. current energy conservation regulations,
California Administrative Code,Title 25, State of California, in the building
located at: I
///7Son JoseAoe — t?7 /6,27-5- •
Street Lot Number Tract Number
' Exterior Walls
Owens-Corning Fiberglas Blanket Insulation 3/ca"
//
Thickness R-Value
Ceilings
Owens-Corning Fiberglas Blanket Insulation /� _ ✓Y
Thickness R-Value
Floors
Owens-Corning Fiberglas Blanket Insulation
Thickness R-Value
Foundation Walls
•
Manufacturer Type Thickness R-Value
General Contractor License No.
By Title • Date
Isignaturel,
I nsulaf ontr for �d "62✓nR 2 .nl/ License No.53311PL/�' —
By • � Zaturet Ow� Title VP Date �"D/-�'/
9naturel
GwEN$/CONNING
FIBERGLAS .
Homeowner Copy (White)
State Copy (Yellow)
Builder Copy (Pink) OWENS-CORNING FIBERGLAS CORP.
Insulation Operating Division
Pub No.16-BL-6995-A Limo in U.S.A.,July 1977 Fiberglas Tower,Toledo, Ohio 43659